Psychiatric evaluation of the face transplant candidate

There have now been a total of 32 face transplants done in the world since the first in Amien, France, in 2005. This procedure is moving from being considered experimental to being considered an accepted option for reconstruction in cases of severe facial disfigurement.

There have been three published reports of prospective quantitative assessments of facial transplant candidates related to psychological outcomes with face transplant recipients. Various instruments have been used in assessment, including the Beck Depression Inventory, Patient Health Questionnaire-9 (PHQ-9), and Center for Epidemiologic Studies Depression Scale for rating depressive symptoms. Quality-of-life instruments used have included the Short Form-12, the Short Form-36, the Euro-QOL-5D (EQ-5D), the WHO Quality of Life rating scale (WHO-BREF), and the Psychosocial Adjustment to Illness Scale-Self-Report.

There have been three deaths in the first 32 cases of facial transplantation (9.4%), two cases of post-transplant lymphoproliferative disorder in the first 20 face transplant recipients (10%). This rate of post-transplant lymphoproliferative disorder is about 10 times the rate seen in solid-organ transplant recipients. Collaborative assessment protocols are needed to determine whether the improvement in quality of life with facial transplantation is justified in the face of the risk of lifelong immunosuppression.